﻿<%@ Page Language="C#" MasterPageFile="~/Site.Master" AutoEventWireup="true" CodeBehind="Register.aspx.cs" Inherits="IDML.Web.Modules.Patient.RegisterPatient" %>

<asp:Content runat="server" ID="BodyContent" ContentPlaceHolderID="MainContent">
    <hgroup class="title">
        <h1><%: Title %>.</h1>
        <h2>Patient registration</h2>
    </hgroup>

    <section id="regform">
        <p class="validation-summary-errors">
            <asp:Literal runat="server" ID="FailureText" />
            <asp:Label ID="lblError" runat="server" CssClass="field-validation-error" />
        </p>
        <fieldset>
            <legend>Register Patient</legend>
            <ol>
                <li>
                    <asp:Label ID="lblTitle" runat="server" AssociatedControlID="ddlTitle">Title</asp:Label>
                    <asp:DropDownList ID="ddlTitle" runat="server">
                        <asp:ListItem Value="1" Text="Mr" />
                        <asp:ListItem Value="2" Text="Mrs" />
                        <asp:ListItem Value="3" Text="Ms" />
                        <asp:ListItem Value="4" Text="Master" />
                        <asp:ListItem Value="5" Text="Rev" />
                    </asp:DropDownList>
                </li>
                <li>
                    <asp:Label ID="lblFirstname" runat="server" AssociatedControlID="txtFirstName">First name</asp:Label>
                    <asp:TextBox runat="server" ID="txtFirstName" />
                    <asp:RequiredFieldValidator ID="rfvFirstName" runat="server" ControlToValidate="txtFirstName" CssClass="field-validation-error" ErrorMessage="The user name field is required." />
                </li>
                <li>
                    <asp:Label ID="lblLastName" runat="server" AssociatedControlID="txtLastName">Last Name</asp:Label>
                    <asp:TextBox runat="server" ID="txtLastName" />
                    <asp:RequiredFieldValidator ID="RequiredFieldValidator2" runat="server" ControlToValidate="txtLastName" CssClass="field-validation-error" ErrorMessage="The password field is required." />
                </li>
                <li>
                    <asp:Label ID="lblGender" runat="server" AssociatedControlID="ddlGender">Gender</asp:Label>
                    <asp:DropDownList ID="ddlGender" runat="server" DataValueField="1">
                        <asp:ListItem Value="0" Text="Female" />
                        <asp:ListItem Value="1" Text="Male" />
                    </asp:DropDownList>
                    <asp:RequiredFieldValidator ID="RequiredFieldValidator1" runat="server" ControlToValidate="ddlGender" CssClass="field-validation-error" ErrorMessage="Gender is required." />
                </li>
                <li>
                    <asp:Label ID="lblPhone" runat="server" AssociatedControlID="txtPhone">Phone No</asp:Label>
                    <asp:TextBox runat="server" ID="txtPhone" />
                </li>
                <li>
                    <asp:Label ID="lblMobile" runat="server" AssociatedControlID="txtAge">Age</asp:Label>
                    <asp:TextBox runat="server" ID="txtAge" />
                </li>
            </ol>
            <asp:Button ID="btnRegister" runat="server" CommandName="Save" Text="Save" OnClick="btnRegister_Click" />
        </fieldset>
    </section>

</asp:Content>
